Clinical Exposures: Palpebral reconstruction after entropion surgery in a dog - Veterinary Medicine
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Clinical Exposures: Palpebral reconstruction after entropion surgery in a dog


VETERINARY MEDICINE


SURGERY


3. Incisions were made on the upper and lower right eyelids to remove the fibrous tissue and cilia, and the incision edges were apposed and sutured in a manner similar to that on the left side.
Anesthesia and surgery were performed a day after presentation. The area around both eyes was minimally clipped, and ophthalmic ointment (Puralube—Fougera) was applied to both eyes. The dog was placed in right lateral recumbency, and the skin around the eyes was aseptically prepared by gently scrubbing it with cotton balls containing dilute baby shampoo (1:2) and alternating three times with dilute povidone-iodine solution (1:50) rinses.


4. The fibrous tissue and cilia have been removed from the upper left eyelid. The dehisced area near the medial canthus was sutured before the new incision was closed.
An incision was made with a No. 10 Bard-Parker scalpel blade in the left lower eyelid skin just ventral to the granulation tissue. The incision extended from the most medial aspect of the tissue to the lateral canthus. Ophthalmic tenotomy scissors were used to dissect under and remove the granulation tissue from the palpebral margins (Figures 3 & 4). The tissue remaining on the edge of the eyelid formed the dorsal part of the surgical wound. The removed tissue contained the aberrant cilia. The skin edge remaining below the wound was freshened and sutured to the dorsal part of the wound along the eyelid margin by using 5-0 nylon in a simple interrupted pattern. The suture ends that were directed toward the cornea were cut short to avoid corneal rubbing while the ends directed away from the cornea were left long to allow for ease of identification upon suture removal (Figure 5). The procedure was repeated for the upper eyelid of the left eye and for both eyelids of the right eye. In addition, in the left eye, the exposed subcutaneous tissue at the medial canthus was débrided and closed with 6-0 Vicryl (Ethicon) in a simple continuous pattern, and the skin was closed similarly to the other eyelid incisions.


5. Care was taken to keep the suture ends closest to the eyelids short, and those away from the eye were left long for easier removal.
Postoperative care was aimed at minimizing pain and self-trauma. The dog was fit with an Elizabethan collar and received 2 mg/kg of carprofen (Rimadyl—Pfizer) and 0.05 mg/kg hydromorphone subcutaneously before recovery from anesthesia. Although it is not our standard procedure to administer prolonged analgesia for most eyelid surgeries, because of this dog's history of intense postoperative pain and the owner's wishes, a five-day course of oral carprofen (2.2 mg/kg) and oral tramadol (3.7 mg/kg every 12 hours) was dispensed.


6. At discharge from the hospital, the dog's eyelids were no longer rolling inward, and it appeared to be comfortable.
The patient was discharged from the hospital the same day as the surgery (Figure 6). The client was instructed to cold pack the dog's eyes twice daily for five minutes to minimize swelling and to continue the previously prescribed cephalexin and triple antibiotic ophthalmic ointment (Trioptic P—Pfizer Animal Health). The owner was warned to expect some swelling and, possibly, a mild, permanent ectropion because of the large amount of tissue that had been removed during the two procedures, which had led to eyelid thinning.


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Source: VETERINARY MEDICINE,
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